The Healing American Healthcare Podcast
The Healing American Healthcare Podcast

Episode 16 · 1 year ago

The State of American Hospital Care


Ed Eichhorn sits down with Dr. Tom Bellavia to discuss the current state of hospital & patient care and break down the reasons it has become so costly while the quality declines. They also touch on the financial institutions currently handling the hospital system and vaccine rollout. 

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"The Discovery" 

by The Lemming Shepards 

Exzel Music Publishing ( 

Licensed under Creative Commons: By Attribution 3.0  

Welcome to the healing American healthcare coalition podcast. Our goal is to provide you with timely, insightful information and important perspectives on healthcare in America. Our mission is to be a trusted, objective source on healthcare issues that impact the well being of all Americans. My name is Ed Ikorn and I'm the founder of our coalition. Today we are very pleased once again to have Dr Tom Bellivia with us to discuss important issues that affect the practice of medicine. Let me tell you a little bit about Dr Belli via. Dr Belli via is a product of the New York City school system and graduated from New York University's Washington Square college with a Bachelor's in biology. He immediately entered the University of Rome Medical School and did his post graduate training in medicine at the Hackensack University Medical Center. After serving in the United States army medical core in Texas and Virginia, where he reached the rank of major and also was chief of professional services at Kenter Army hospital, he returned to the attending staff at Hackensack University Medical Center. Dr Belli via has been an advisor to both the state of New Jersey and and federal governments on healthcare issues and was recently invited to serve as the chair of the New Jersey Department of Health and Senior Services Task Force on chronic kidney disease. He is board certified in Family Medicine and Correctional Medicine. He's a senior attending at the Department of family practice, attending at the Department of Medicine and associate professor at the University of Medicine and Dentistry of New Jersey. Dr Belle via is a member of the board of Trustees of the New Jersey Academy of Family Practice and its foundation, the New Jersey Academy of Family Physicians and the American Academy of Family Physicians. He is chairman of Astar Health, providing hippo compliant health information technology and application integration services for fit positions, hospitals, patients and insurance providers. He is active in many additional organizations with philanthropic missions. Dr Belli via began his practice of family medicine in Woodridge and subsequently created heights medical associates in the hasporoke heights where he still sees patients every day. Thank you for joining us today. Thank you. In the morning, you know, I'd like to ask you some questions about an article we've seen called overcoming the market dominance of hospitals, that was published by the American...

Medical Association, and there are a couple of points about it that I thought we should discuss. The first one is that this article reported that hospitals continue to dominate by buying the doctors practices. In fact, between two thousand and sixteen and two thousand and eighteen eight tho practices, including fourteen thousand physicians, were acquired by hospital systems. In addition, over the last two years, surveys of hospitals have been acquired by hospital systems showed data that indicated that the quality of service went down. I wanted to ask you how does this trend for hospitals to acquire doctors practices actually in fact the practice of medicine? So it affects so many things, not only to practice in medicine, but also affects our patients as well and our country and government and courses and increase in course to healthcare, of course, the spectrum. It's interesting to know that when the consolidation started several years ago, I was amazed at the fact that it was going to happen when all of the literature had spoken about all consolidations or failure. It did not improve any quality and it will cost a lot more money. Did Not save any money for you got them. Yes, these hospitals went forward and convinced our legislators that this is what would happen, they would have better quality in our state and that the course of healthcare with good down. Of course, throughout this period of time of consolidation, that has not been true. In fact, Ivery I told one of the hospital presidents at that time that I hope you have a good time putting all these together and hope you have just a good times that when the people finally wake up at what's really going on here, is that you have much fun taking it apart, just like at t did in the past. The reason for these and the big part as far as the practice of medicine and even affects, for instance, of Value Base Care, where you're trying to save money by being very careful and very, very diligent in providing care, and the safe environment of value based and so on. What happens is it comes a point now that you can only reducualization runnecessarialization and could out waste to a point that it no longer matters because the unit course to re writing care due to these consolidations outpaces it. So if you get an increase in uni course at hospital at sixty ten percent every year, they're going to come a time where are reduced in utilization and cutting out the waste is not going to match. It's going to be a disaster at that moment. So it has a direct effect, of course, the whole spectrum of healthcare up together and also gives me a point of view. When I think about I see on TV and advertising of these consolidated hospital systems. I often wondered why they spend so much money on advertising and how much money they spent on a hierarchy of executives. If one can think that you can save or use some of those money spent... those areas into healthcare itself, for provisional health care, we'd all be better well. So why do they do all the Sati the time? They have to get a bigger market share as they possibly can, and also interesting to note that, according to the way they do this is these hospital systems have to have what they quoted. Must have services such as organ transplant, cardiac surgery and some one where any payer or independent business that self insurers must have in their panel to provide for their employees. It makes it very, very difficult to compete against that at the level of a primary prick care practice. So these are very important issues that have to be addressed again by government and legislative and, of course, the people, because it's affecting them seriously. They are not getting quality care anymore. It's, course, in them the fortune and the reasons for most private bankruptcies of course, the healthcare. So I think the consolidation of hospital systems has to be clearly looked at again and re examined and changed. As you will know, when hospitals acquire a position and practice they also can build a facility for the associated with so many raises the course of health care. That raises the courst of health care, and you mentioned the important point. When acquisitions occur, hospital will say that quality will go up and cost will go down, and cost definitely go down, but their prices go up. Over the last ten years, year to year, that increased cost for hospital systems with private insurance has been between twelve and seventeen percent a year. In some cases, not in our part of the country, but out west, there have been consolidations where a hospital system might serve seven to ten states. These multi state hospital systems are going to be very detrimental to paions. So the thing that I always wonder about is helping you control that. I was thinking and I wanted to get your thoughts on this. I think you should allow mergers to occur, but by law, when the merger occurs they should be told you can't raise your crisis for five years. They said Uni course is which is what's destroying. It's right now, the uni course that is being demanded by his consolidations. Like I said before, far out weighs the are ethics of the tail utilization, I mean on a quality since you could tell unization that, not just could telling you for safe tailing is what's it's going to destroying valuation program I think it's destroys a value base program the country health you will be a disaster coming from. How do these impacts of these consolidations actually affect you and your data day practice, and are things that you try to do to maintain and stabilize these issues within your practice? Yeah, this is his a division. What we find in delving the healthcare most of the specialists have now been void by the hospital. So the ability for the access to these specialist is fall limited.

I prove to a hospool system ones that you can't get ahold of a specialist. Take any speciality where we want. What the Peace Poiology? Whatever will you do? Is You get and answering machines to leave a message? I can't tell you how many men, patients calling me back and say that these specialists that are owned by hospitals for the most part don't return their calls, limited hours, and there is a special reason for that. I think, and I did a study of multiple primary care practice is owned by your hospital system with the physicians were not happy. Number One. Number two, they were indented servants to the hospital. They now practice corporate medicine and have to answer to the corporate entity of the hospital and not to the patients for that matter. They are in enough play to earn this status and close the door. So if they are in the salary by five o'clock, they stopped working. They just an available the ability to get patients into these offices takes months. Sometimes, I can guarantee in some practices, if you're call for appointment today and it's April sixteen, that patient may get an appointment in junior July. The access has been slowed, the quality has decreased. The compassion to the patient, I feel, is gone. It's entering to the master entry Tam like I get my RBUV's I got to do this and and I don't have to respond. It's a horrible situation, you know. As a corollary to this, Dr Beldia, how is the pandemic impacting, if it is at all, the efforts of hospitals to acquire practices and other hospitals? Well, I think it's made it easier. You know, a lot of the primary get practice. We're writing on various margins and with the covid situation and the ability of patients that coming in and some practice slogan to the Tele Medicine, their income has been ready to do so. They're easy ticking. Now behostiles to offer them good deals. Is this issue, in terms of availability and additional requirements that you've described, impacting physicians leaving the profession or retiring or their less positions now. Oh yes, the amount of physicians that are, quote Unquote, burning out is on the increase. Doctors are retiring a lot earlier than they had wanted to. Health Care Right now physicians are in real problems financially. They're struggling keeping abreast of all the regulations and spending more time in following regulations and actually seen patients has become a serious problem for physicians, at least in primary and I think that's the reason why most of these doctors, even in specialties, are trying to consolidate as well. So how do you think this kind of a problem, that's going to be a massive problem as we go forward, could be addressed? What do you think our lawmakers order to do in order to provide a proverbial light at the end of the tunnel? Well, I think that first of all, the mechanisms that the government has used to allow the insolidations of hospital has to be reviewed. It...

...seems to be very complex situation, but also takes in to account the expense of the referral patterns for hospital. There's, example, the article about New York City. You know, the people don't travel from borough to borrow to get their care you got to remember the medicine is a very local business and they really go to place nearby. So that route, cause of how the government allows that to happen, is essential. The two things that I like about that's happened recently is the situation out in California, where California stopped the overgrowth insolidations, and also locally here in New Jersey, where the federal government has stopped the acquisition of Anglewood Hospital by the set forridium system, saying that that might be too much of the monopoly here. But I think with these minor cracks in the walls of these consolidations and if the public became more aware how these consolidations are affecting them person as to get quality of care at they're going to receive and the course that's costing them out of pocket, and the difficult position that the health clines are put in because they must steal with these hospital dominant places because they must have those services to be either TPA most health insurance. Now our TPA is more than actually giving shirts. It's a major problem. I think it has to be started with either federal government looking at the rules of regulations. I think it has to be looking at the state levels and on the rules of regulations and to put a whole to this. Positions can, I conpee, to maintain quality and or to reduce forced as long as the unit prices keep going up due to the downs to the hospital systems? Absolutely, I think this is a huge problem, as you've outlined, and I think we need to help make people aware of this, because it all comes back to the care that a patient needs when they need it. And if you have a patient that needs to see a specialist but they can't go to see him for twelve weeks, that's getting to sound a little bit like the problems of the queue in the National Health System in Great Britain of years ago, when they just underfunded their budget and people had to wait a long time you see a specialist. I mean exactly a lot like that. Yeah, you know the issue here. If you want to save money, you got to keep the people healthy. The longer patient can get to the specialty care, the more probably that pictures going to get sicker and quite a lot more in funds to stay well. It's a very vicious circle. I think a lot of the problem is that politicians, for the most part, really are afraid to deal with healthcare. I think you know when you're a patient and you're in a stretcher and you look it up at the ceiling and they went too surgery or some emergency, the patient is really interested in saving money. Bill the RES is getting better and get the best at ten and whod health care. So much your course. I think that politicians, when they start to try to work in the healthier system, that you try to make it better, they're fraid to upset that conception. Patients don't mess with my healthcare because I need it now and I don't care how much it was. I think by educating the public on these things in the public realize it. It' also need this interest. It might make things change. We... need some politicians to read this by the horns and really bring it forth. I was speaking to a congressman a few years ago and I was asking him some questions about changing healthcare and universal healthcare, and he looked at me and said, look, everyone wants to control the cost of healthcare till they gets that's right. It's exactly point I'm making. You know, when when you're sick, you don't get how much the coursed, even though somebody else can be paid for issue. Is Everybody's that ends up paying for it. When you success I've been giving, people come back to me and say, Oh, I don't want socialized medicine and I say, well, we're not trying to support socialized medicine, but we can make changes that improve outcomes in the lower cost for you and for everybody. But we can do a better job with the dollars we spend, because we send dollars in our also at at least to another problem where people say can't get access, they go to the mergency room. And where's the highest cours Care Deil? It's an emergence emergency room. The you know they go there they think they're going to get the care. It ends up that the hospitals are incentivised to admit people at least it to observation units where they can get a lot more money and it's a dollar game and they keep driving patients to the are you us to get a crowded the kids wind those quality of kids windows and I see that on people coming out of a burgess rooms all the client when they follow up in their office that you know they would never really give an adiquate care. It's hard. You Up to getting mint or out or admittance so they can an admit thements observation where they can then go for fee for service rather than a Darg value. And hospitals are making a fortune in moneys. Well, you know, I think these are important issues and we need to get them to our lawmakers and we need to help them with this very complicated problem, because it's not easy to solve. But it could be solved by the suggestions that you've made to move forward with them, better control of hospital mergers and allowing positions to actually practice medicine and not take care of their patients. Oh absolutely, I think they should relieve the burdens of the positions with the government tries to save moneys by putting these road blocks of pre certifications on the saying that all of them are not necessary, but they make it impossible to practice medicine because in some cases, in some plans, I have to prestart talent all the indigen patients because they are allowed to get it paid by the government, so it has to be presertified. Things like this are ridiculous and so on. I'm not saying that there isn't a lot of way ship by positions as well. This is, you know, everybody has a little bit of Fourth Innes, but I think but a good education by the people who are paid for this, that's to buy this, the patients. They would have a bigger say in what's going on and they ought to be much more educated. There's a lot of areas we're things can be much better, there's no doubt about but we need legislators and people in power to be able to accept that...

...role and to deal with correctly. I give credit to one insurance company that says we're not going to pay for imaging done in a hospital setting as an AP patient because the course there is five times if you do it through a local imaging for place. So I'd like to see other health plans come out with that same guts and say no. So there's a multitude of areas in which healthcare can be helped, quality can be increased. In fact, I got to report yesterday on our Rosal Group that in compliance for medications we get five stars, which is really interesting. I bring that up only because of the fact that the biggest course now that I see in health care is farmer and there's no control on the course of health care in farmer and primary care. Physicians don't have the ability because we don't prescribe those means. We don't conscribe cancer meds at of course, we don't prescribe these biological seat of the course and so on, and nobody can put a stop to that increasing course and farmer. So there're a lot of areas where healthcare can be helped. I'm not talking about socialized medicine or don't give me wrong, but there are some common sense answers to the High Court of filth care and the decline in the quality. Absolutely well, I want to thank you for this discussion, but I want to answer questions on a completely different thing for a moment, if I'm there. Absolutely. I've been learning that in our state, in New Jersey, physicians are not permitted to dispense their covid vaccines and I wanted to ask you about that because it seems to me patients who are shut ins or children or who are in minority communities that are afraid of the virus would benefit if when they visited their doctor, they could actually get the vaccine. Right then it's there's something I'm missing in why physicians are not allow you to this. Yeah, it's a little complicated and his story. I think we had been prepared to give out vaccines. We went through all of the necessary regulations by our state, we got the necessary freezes and so on, and then told listen, guys, when I give you vaccine, the reason is that the federal government and both the trunk and it Biden collustration have cut out the local physicians. It's not biden or trunk, that both of them. But the reasons for that, they say, is that they want to get as many people in the country vaccinated as fish as they can. So theyn looking at locations that can probably vaccinate post of the three four thousand patients today rather than into a family practice way. Maybe we can do several hundred a day. But there is some benefits and going to the primary care physicians say. Number One, there is a lot of hesitancy now against the vaccine, especially now that there is a turmoil about jj in the pause. There's also the issue of the Asturs Enica problem that came about. The patients to becoming more fift of getting the vaccines. So the one person that can really help...

...with. That is the primary get physician to talk to the patients and convince them that this is a good thing could do, and we certainly believe it. I'm mom vaccinated and I think that's one year that in the scene. The second we take care of a lot of shuttings. I might practice I probably have close to one thousand seas citizens that of shutters and not always equipped and able to get even if they can get online and get to a place, they can't get there. So we have the capacity to go to these songs and give these vaccines to the most vulnerable population. The second thing is, and there were, I think, groups that some of our doctors take care of. I have a colleagues that take care of the Latino community right another underserved areas. There's a physicians that I know in African American locations that then not getting the vaccines. That could be very helpful to those vulnerable groups as well. But yet our commissioner and our governor and maybe even at the federal level this is not want to hear this, or they do here and they do not respond to it. So the other issue one this is the lack of vaccines that stay. So I was just told now that New Jersey is going to get less vaccines in the next couple of weeks than they had before. So these are all factors and why the physicians are not getting it. But I think that if they do forzero patients a day, so we do five or six hundred, but you multiplied them, but ten of twenty or thirty family practitions, guess what? We get to four, FIVEZERO patients to day and we get to the most vulnerable groups and we give it to the endancy sometimes. So I have to get through. Yeah, well, I think it's some reason. Don't keep trying to impress upon them, because the sooner we get to the point where seventy or eighty percent of the people in our state or around the country are vaccinated, the better off we all are. But we can't get there if we don't get the folks that are hesitant to get the vaccine and the people who are unable to get to vaccinations station. I do not that the American Academy Family Physicians and New Jersey Academy family physicians has been trying very hard since December in contacting and even probably relations in news papers trying to embarrass these people to get to an area where they could understand a point of view. So I will say that government is listening, but not respund. Well, Dr Bellavia, I want to thank you for joining us again today. We appreciate the fact that you're willing to take the time to bring your important views and positions to our listeners and we hope to speak to you again issues come forward that then need to be addressed by someone with great experience like yourself. So thank you very much, Dr Bella, and thank you for the opportunity and stay Welles they say,.

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